title: ATLANTIC DIP: simplifying the follow-up of women with previous gestational diabetes.
abstract: OBJECTIVE
  Previous gestational diabetes (GDM) is associated with a significant lifetime risk of type 2 diabetes. In this study, we assessed the performance of HbA1c and fasting plasma glucose (FPG) measurements against that of 75 g oral glucose tolerance testing (OGTT) for the follow-up screening of women with previous GDM.
  
  
  METHODS
  Two hundred and sixty-six women with previous GDM underwent the follow-up testing (mean of 2.6 years (s.d. 1.0) post-index pregnancy) using HbA1c (100%), and 75 g OGTT (89%) or FPG (11%). American Diabetes Association (ADA) criteria for abnormal glucose tolerance were used.
  The ADA HbA1c high-risk cut-off of 39 mmol/mol yielded sensitivity of 45% (95% CI 32, 59), specificity of 84% (95% CI 78, 88), negative predictive value (NPV) of 87% (95% CI 82, 91) and positive predictive value (PPV) of 39% (95% CI 27, 52) for detecting abnormal glucose tolerance. ADA high-risk criterion for FPG of 5.6 mmol/l showed sensitivity of 80% (95% CI 66, 89), specificity of 100% (95% CI 98, 100), NPV of 96% (95% CI 92, 98) and PPV of 100% (95% CI 91, 100). Combining HbA1c ≥39 mmol/mol with FPG ≥5.6 mmol/l yielded sensitivity of 90% (95% CI 78, 96), specificity of 84% (95% CI 78, 88), NPV of 97% (95% CI 94, 99) and PPV of 56% (95% CI 45, 66).
  
  
  CONCLUSIONS
  Combining test cut-offs of 5.6 mmol/l and HbA1c 39 mmol/mol identifies 90% of women with abnormal glucose tolerance post-GDM (mean 2.6 years (s.d.1.0) post-index pregnancy). Applying this follow-up strategy will reduce the number of OGTT tests required by 70%, will be more convenient for women and their practitioners, and is likely to lead to increased uptake of long-term retesting by these women whose risk for type 2 diabetes is substantially increased.
authors.affiliation: Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: Noctor
authors.forename: C
authors.initials: C
authors.lastname: Crowe
authors.forename: L A
authors.initials: LA
authors.lastname: Carmody
authors.forename: G M
authors.initials: GM
authors.lastname: Avalos
authors.forename: B
authors.initials: B
authors.lastname: Kirwan
authors.forename: J J
authors.initials: JJ
authors.lastname: Infanti
authors.forename: A
authors.initials: A
authors.lastname: O'Dea
authors.forename: P
authors.initials: P
authors.lastname: Gillespie
authors.forename: J
authors.initials: J
authors.lastname: Newell
authors.forename: B
authors.initials: B
authors.lastname: McGuire
authors.forename: C
authors.initials: C
authors.lastname: O'Neill
authors.forename: P M
authors.initials: PM
authors.lastname: O'Shea
authors.forename: F P
authors.initials: FP
authors.lastname: Dunne
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002852:Chromatography, Ion Exchange; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology; D016640:Diabetes, Gestational / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000175:diagnosis / Q000209:etiology; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D012372:ROC Curve; D012107:Research Design
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin